The novel coronavirus (COVID-19) pandemic has highlighted Africa’s overdependence on imports to meet vaccine needs for epidemic response and routine immunization. The continent imports over 90% of its vaccines. In response to these needs, the African Union (AU) and the African Centres for Disease Control and Prevention (Africa CDC) launched the Partnerships for African Vaccine Manufacturing (PAVM) in April 2021 to increase domestic vaccine production from 1% to 60% within the next two decades. This move aligned with the United Nations-brokered declaration (2021) on vaccine equity supported by more than 180 countries. The PAVM aims to create manufacturing hubs in five regions: North, Central, West, Southern and East Africa leveraging existing and emerging capacities.
Governments and Multilateral Institutions
There is growing support for the initiative from governments, development finance institutions (DFIs), foundations and public-private coalitions. In April 2021, the Coalition for Epidemic Preparedness Innovations (CEPI) agreed to work with the AU and Africa CDC on vaccine R&D and manufacturing. Simultaneously, the World Health Organization launched an mRNA vaccine technology transfer hub in South Africa. In May, the World Health Assembly adopted a historic resolution to promote sustainable local production of health technologies for public health emergencies and routine immunization within integrated markets.
In June 2021, G7 leaders agreed to support “African efforts to establish regional manufacturing hubs.” In October, G20 leaders endorsed expansion of local production capacity, with explicit support for the vaccine hub in South Africa and the COVAX manufacturing working group. While the United States has pledged to donate over a billion COVID-19 vaccine doses for global use, the US International Development Finance Corporation and partner institutions are investing in vaccine production in Senegal and South Africa. In July 2021, Pfizer and BioNTech announced a partnership with South African Biovac to produce COVID-19 vaccines. Aspen Pharmacare has begun production and export of the Johnson & Johnson vaccine. Both Biovac and Aspen are engaged in fill-and-finish.
The European Union intends to invest in enhancing manufacturing capacity in specific hubs with support for research, supply chain and regulatory systems strengthening. France and Germany have made specific commitments through their DFIs to contribute to regional manufacturing of vaccines. The United Kingdom supports feasibility studies at strategic sites. And at the 2021 G20 Summit, Canada announced financial support for the technology transfer hub in South Africa.
Chinese companies have initiated production partnerships in Egypt, Algeria and Morocco. As Egypt aspires to be a regional production hub, the Egyptian Holding Company for Biological Products and Vaccines (VACSERA) has produced millions of Sinovac vaccine doses. In Algeria, Saidal and Sinovac have commenced production. There is also a China-Morocco partnership for biotech capacity development, with a deal between Sinopharm and Sothema to produce pandemic shots.
Beyond the Chinese focus on North Africa, Sinovac and Numolux are exploring building a manufacturing facility in South Africa after the completion of a major clinical trial. In addition, the Chinese government proposed a new vaccine production initiative at the (G20) Rome Summit to facilitate effective coordination of vaccine research and technology transfer to its global partners.
Russia has partnerships with two Egyptian companies (Minapharm and BioGeneric Pharma) and the Algerian Saidal to produce the Sputnik V Covid-19 vaccines.
Foundations and Philanthropies
Philanthropies have also begun advocating for expansion of production capacity in developing countries. The Bill and Melinda Gates Foundation has called for new investments in vaccine research and development in middle-income countries, with support for the African initiative. The MasterCard Foundation launched a new initiative with the Africa CDC in June 2021. And a coalition of leading global and African philanthropies has committed to galvanize global efforts towards vaccine equity in the ongoing pandemic response with long-term commitment for building manufacturing capacity in emerging and developing economies.
Global and regional foundations have significant leverage with governments, biopharmaceutical industry leaders and researchers. They have a vital role to play in shaping pharmaceutical innovation research to address unmet needs and neglected tropical diseases in developing countries. They can support local production capacity with risk-tolerant and patient capital and facilitate South-South cooperation. They can help to sustain political commitment through engagement with policymakers. Their relationship with manufacturers offers a window of opportunity to facilitate knowledge partnerships and technology transfer to new sites using available institutional networks. In a precarious world, the convening power of an altruistic global health philanthropic collective can help to reconstruct systems for equitable access to health technologies in Africa.
Regional financial institutions and national banks have also aligned with the vision to increase regional production of vaccines in specific hubs. The African Development Bank aims to invest $3billion in local production over a 10-year period. The African Finance Corporation and the Afreximbank intend to work on project development and financing. At the national level, the Central Bank of Nigeria launched a research financing support for target companies with positive feedback on its ongoing implementation. The Nigerian Sovereign Investment Authority also intends to mobilize capital to complement the Apex Bank’s efforts to boost local production of health and pharmaceutical products.
It is crucial for global, regional and national financial institutions to work together to improve access to finance for enterprises working across the pharmaceutical value chain. Although the current financing focus is on vaccine manufacturing, there are ancillary opportunities in production of generic medicines, diagnostics, and key health supplies like masks and syringes. Although it could be challenging to have a pooled fund, it is possible to explore joint pipeline development and project financing leveraging the mapping exercise conducted by CEPI and other partners.
One approach is to evaluate the effectiveness of the African Vaccine Acquisition Trust (AVAT) and the COVID-19 Response Fund to identify lessons to create an African Pharmaceutical Innovation Trust. The trust can support a market mapping exercise and coordinate innovation investments with public, private, academic, philanthropic and citizen coalition partners to align with PAVM, the Pharmaceutical Manufacturing Plan for Action and Agenda 2063. As the Global Fund potentially transitions (focusing more on pandemic preparedness and financing in addition to its current focal areas), with stronger partnerships with the World Bank, WHO, CEPI, UNICEF and GAVI the Vaccine Alliance, these global institutions will be great partners in health technology production and distribution.
From Commitment to Consistent Action
In response to COVID-19, African countries have secured access to available vaccines through direct deals, a pooled procurement platform like the African Vaccine Acquisition Trust and multilateral initiatives particularly the COVID-19 Vaccines Global Access (COVAX) Initiative. Yet, inequity resulting from multiple interrelated factors has led to poor vaccine coverage. The good news is that Egypt, South Africa, Algeria and Morocco have begun Covid-19 vaccine production using pre-existing capacity as Senegal, Rwanda, Nigeria, Ghana and Kenya are also gearing up to enter the production race. Nearly all production facilities are doing fill-and-finish, the last stage of vaccine production. Increased local production and AVAT/COVAX deliveries are expected to increase vaccine availability in 2022 (and beyond), requiring accelerated efforts to meet national and global vaccination targets.
The successful implementation of PAVM requires specialization in country focus and workforce development. In advanced economies, biopharma companies are increasingly specializing in specific elements of the value chain such as omics analysis, drug discovery, bioinformatics, clinical trial logistics, regulatory support, delivery technology and investment advisory. While South Africa, Senegal, Egypt and Rwanda can be hub leaders, other countries can develop enterprises focused on specific segments within an interdependent and resilient value chain.
A recent mapping by the Clinton Health Access Initiative (CHAI) shows that Africa has so far received the largest donor commitments for domestic production of vaccines compared to other regions: development partners announced over $3 billion to boost production capacity on the continent. Turning this commitment into catalytic long-term investments hinges on continuous advocacy and sustained political will – a crucial role for the Africa CDC, the People’s Vaccine Alliance and partner institutions.
Linkage to Global Expertise and Value Chains
A recent evidence synthesis by UK’s DFI shows that the use of new technologies, efficient business models, high-quality organizational reforms with adequate investments can boost productivity in an industry with spillover effect to other sectors and firms. This insight is useful as African countries prioritize increasing capacity for local production of vaccines to guarantee domestic and regional health security.
The African diaspora represent an important channel of knowledge, technology and investment transfers. Building on the recent investment of Dr. Patrick Soon-Shiong, a renowned pharma executive, in academia-industry partnership in African institutions, African leaders can create an African Diaspora Group. This can help harness the skills, networks and investments of people of African descent in global institutions for clinical research, technology transfer, regulatory system strengthening and other areas of pharmaceutical industry development.
As the African Medicines Agency becomes functional and the African Medical Supplies Platform is widely used, end-to-end transformation of the pharma value chain can contribute to better access to safe and effective health products across the continent. The vision to enhance production capacity in Africa is not a battle against big multinational manufacturers: it is a clarion call for partnerships and adequate investments in the market of the future, which expands the global market. The ‘’long walk’’ to self-reliance in regional production of vaccines has begun with remarkable progress: it is a worthwhile journey in the best interest of all African and global citizens. As the International Monetary Fund Managing Director Kristalina Georgieva recently noted, ‘’it is increasingly clear that a robust and reliable vaccine capacity in Africa is a global public good that deserves global support”.